Laserfiche WebLink
� r <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ' <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)46$-3420 <br /> 11 P O BOX 20099 STOCKTON, CA 95201 <br /> -PERMIT EXPIRES I. YEAR FROM DATE ISSUED <br /> 1 <br />{ (Complete in Triplicate) <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This <br /> application is made in compliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San <br /> Joaquin County Public ealth Services. <br /> Job Address <br /> City Lot '✓f <br /> Uixe/Acreage <br /> I ' I <br /> Owner's Name Address fj�l?3-3 <br /> Phone <br /> 4 S/,6 <br /> Contractor � Address-��t�� <br /> License No GS hone •!We71lLj TYPE OF WELL/PUMP: NEW WELL ❑ WELL RE LACEMENT n DESTRUCTIDN Out of Service PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ Monitoring DISTANCE 1f0 NEAREST: SEPTIC TANK SEWER LINES <br /> lDISPOSAL FLD. PROP. LINE <br /> FOUNDATION"!_I, AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS V' } <br /> Industrial ❑ Open Bottom? ❑ Manteca Dia, of Well Excavation <br /> f:3 <br /> Domestic/Private ❑ Gravel Pack* ❑ Tracy Dia. of Well Casing <br /> Type of Casing_ Specifications <br /> I'] Public 1-1 Other �] <br /> n Delta Depth of Grout Seal <br /> I i frri 0'ation Type of Grout <br /> ,.....AppraK. Depth i I Eastern Surface Seal Installed by <br /> Repair-Work.-Done-0— pe of-Pump-- <br /> Well Destruction t r � Sta�erWork one <br /> }d Well Diameter � Sealing Matexigl.4li--Depth - - <br /> Filler-Matertsl--&Depth <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION.I I REPAIR/ADDITION E I DESTRUCTION f I INo septic system permitted if public sewer is <br /> lnatallation will serve: Residence # ` available within 200 feet.) <br /> ftii/CommerciAl JOther, —AZ_Z . <br /> A # <br /> : . It'"_- <br /> Number qt living units: Number af[[1bedrooms <br /> Character of-sdil o adepth't13Yee-: <br /> SE41C TA7NK------©ZypWater table depth V � <br /> e/Mfg ' CapaGity. � No, Compertrnenta <br /> PKG. TREATMENT PLT. ❑ <br /> Method of; <br />